Healthcare Fraud: Nowadays, it has become all too common to read about healthcare fraud in the news and social media. It has become a major problem in the United States that accounts for millions and dollars of loss every year.
So to protect yourself against fraud, the very first thing you should do is to arm yourself with the proper knowledge about our healthcare system. This way, you can easily spot, correct, report, and prevent healthcare fraud from even happening in the first place.
With that, we have created this guide to help you understand how our healthcare systems work and what are the red flags you should look out for.
Fraud in the healthcare industry can come in many forms. It can stem from hacking incidents leading to identity theft, false claims for services that were never rendered, and even doctors getting kickbacks from referring you to their close business partners.
So for this article, we would specifically look at fraud that can be easily detected by ordinary Medicare/Medicaid members like you. These are the types of health care fraud that can be easily detected and prevented.
Very basically, identity theft is when someone uses your Medicare number or health insurance account number to buy their prescription drugs, get a consultation, submit claims with your insurance provider, or anything that is related to medical care.
“Medical identity theft is alive and well in the United States,” as concluded by the Federal Trade Commission in this report.
That said, you should protect yourself against identity theft. Through this type of fraud, you might have a hard time accessing your health insurance benefit and the thief might even hurt your credit.
To combat this type of fraud, here is the list of things that you should do
- The most obvious one is to simply not share your health insurance number and other personal information with anyone else.
- Be wary of scammy emails. Make sure that the email address is legitimate and avoid clicking links without verifying its source. If the email asks you to change your password or ask for any personal information, then it might be best to contact your insurance provider first before doing anything else.
- Avoid using public or free WIFI when logging in to your online healthcare account. Only use a device that you trust when logging in.
- Remember that Medicare would only call you if you are already a member. No one from Medicare would ask you to join Medicare via telephone.
- Do not give your Medicare number via telephone call.
- A great rule of thumb is to only give your Medicare number to your doctor, insurers acting on your behalf, and trusted agencies who work with Medicare as well.
There are many different types of false claims and you might even need a healthcare fraud attorney to explain it all for you. But in its most basic form, a false claim is when your medical provider submitted a claim that you never received.
For example, you went to the doctor’s office, had a simple consultation, and got a simple procedure. However, a few days after your doctor’s visit, you noticed that your medical service provider filed a claim to Medicare for a complex and costly procedure. This is considered a false claim because you only went to the doctor’s office for a simple procedure and you never received the complex procedure that they filed.
Keep in mind that there are other types of false claims besides the example stated above. So in order to help you spot, avoid, and prevent it, we have listed a few things that you should do:
- You should always keep the records and save the receipts every time you get a prescription or receive any type of medical service.
- Every once in a while, you should compare these records with the claims processed by Medicare online (www.MyMedicare.gov). If there are any inconsistencies, then you should immediately file a report to Medicare.
Other than the ones stated above, here are some red flags or suspicious activities you should look out for from your medical service provider
- If they keep offering you free stuff and services in exchange for your Medicare number to be put in their records.
- When they provide more tests, but the cost keeps decreasing every time
- If they can easily charge copayments without checking your ability to pay
- When they insist or pressure you to undergo unnecessary tests or treatments
- If they offer money or any type of kickbacks in return for them to use your Medicare number
- When they bill Medicare for unnecessary stuff you do not actually need like a back-brace, power wheelchair, scooter, genetic test, and others
All in all, you should always protect your health insurance information and check your records every now and then. This way, you can easily protect yourself against any type of healthcare fraud that comes along your way.